Probiotic capsules and xylitol chewing gum to manage symptoms of pharyngitis: a randomized controlled factorial trial
Probiotic capsules and xylitol chewing gum to manage symptoms of pharyngitis: a randomized controlled factorial trial
Background. Reducing antibiotic use for upper respiratory infections (URTIs) is needed to limit the global threat of antibiotic resistance. Our aim was to estimate the effectiveness of probiotics and xylitol which could plausibly improve the management of pharyngitis.
Methods. This was a parallel group factorial randomised controlled trial. Participants in primary care aged 3 and over with pharyngitis were randomised by nurses providing sequential intervention packs. Pack contents for three kinds of material/advice were previously determined by computer generated random numbers: a) no chewing gum b) xylitol based chewing gum (15% xylitol; 5 pieces/day) and c) sorbitol gum (5 pieces/day). Half of each group were also randomised to receive either probiotic capsules (containing 25x109 colony forming units of lactobacilli and bifidobacteria) or placebo. The primary outcome was the self-reported mean severity of sore throat and difficulty swallowing (0-7 scale) in the first 3 days. Multiple imputation avoided assuming data was missing completely at random.
Results. 1009 individuals consented, 934 completed baseline assessment, and 689 provided complete primary outcome data. Probiotics were not effective (No probiotic mean severity score 2.75, Probiotic 2.78, adjusted difference -0.001 (95% confidence intervals -0.24 to 0.24, p=1.00), neither was chewing either sorbitol (no gum 2.73, sorbitol 2.72 (difference 0.07, -0.23 to 0.37, p=0.65) or xylitol 2.73 (difference vs no gum 0.01, -0.29 to 0.30 p=0.96). No secondary outcomes were significantly different between groups, and no harms were reported.
Interpretation. Neither probiotics nor advice to chew xylitol-based chewing gum are effective for the management of pharyngitis.
E1543-E1550
Little, Paul
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Stuart, Beth
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Wingrove, Zoe
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Mullee, Mark
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Thomas, Tammy
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Johnson, Sophie
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Leydon, Geraldine
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Richards-Hall, Samantha
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Williamson, Ian
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Yao, Lily
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Zhu, Shihua
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Moore, Michael
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Little, Paul
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Stuart, Beth
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Wingrove, Zoe
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Mullee, Mark
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Thomas, Tammy
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Johnson, Sophie
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Leydon, Geraldine
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Richards-Hall, Samantha
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Williamson, Ian
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Yao, Lily
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Zhu, Shihua
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Moore, Michael
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Little, Paul, Stuart, Beth, Wingrove, Zoe, Mullee, Mark, Thomas, Tammy, Johnson, Sophie, Leydon, Geraldine, Richards-Hall, Samantha, Williamson, Ian, Yao, Lily, Zhu, Shihua and Moore, Michael
(2017)
Probiotic capsules and xylitol chewing gum to manage symptoms of pharyngitis: a randomized controlled factorial trial.
Canadian Medical Association Journal, 189 (50), .
(doi:10.1503/cmaj.170599).
Abstract
Background. Reducing antibiotic use for upper respiratory infections (URTIs) is needed to limit the global threat of antibiotic resistance. Our aim was to estimate the effectiveness of probiotics and xylitol which could plausibly improve the management of pharyngitis.
Methods. This was a parallel group factorial randomised controlled trial. Participants in primary care aged 3 and over with pharyngitis were randomised by nurses providing sequential intervention packs. Pack contents for three kinds of material/advice were previously determined by computer generated random numbers: a) no chewing gum b) xylitol based chewing gum (15% xylitol; 5 pieces/day) and c) sorbitol gum (5 pieces/day). Half of each group were also randomised to receive either probiotic capsules (containing 25x109 colony forming units of lactobacilli and bifidobacteria) or placebo. The primary outcome was the self-reported mean severity of sore throat and difficulty swallowing (0-7 scale) in the first 3 days. Multiple imputation avoided assuming data was missing completely at random.
Results. 1009 individuals consented, 934 completed baseline assessment, and 689 provided complete primary outcome data. Probiotics were not effective (No probiotic mean severity score 2.75, Probiotic 2.78, adjusted difference -0.001 (95% confidence intervals -0.24 to 0.24, p=1.00), neither was chewing either sorbitol (no gum 2.73, sorbitol 2.72 (difference 0.07, -0.23 to 0.37, p=0.65) or xylitol 2.73 (difference vs no gum 0.01, -0.29 to 0.30 p=0.96). No secondary outcomes were significantly different between groups, and no harms were reported.
Interpretation. Neither probiotics nor advice to chew xylitol-based chewing gum are effective for the management of pharyngitis.
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More information
Accepted/In Press date: 22 August 2017
e-pub ahead of print date: 18 December 2017
Identifiers
Local EPrints ID: 413447
URI: http://eprints.soton.ac.uk/id/eprint/413447
ISSN: 0820-3946
PURE UUID: 86d4daa3-b58b-4b0c-9d00-e751d5033272
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Date deposited: 24 Aug 2017 16:30
Last modified: 16 Mar 2024 05:40
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Author:
Zoe Wingrove
Author:
Sophie Johnson
Author:
Samantha Richards-Hall
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